Study Reports on Fixing an Electronic Communication Problem that Reduced Follow-Up of Positive Cancer Screens at VAMC
FINDINGS:
- A problem with software configuration at one VA medical center intended to alert VA primary care physicians about positive colorectal cancer screening (FOBT) results led to breakdowns in transmission of a subset of test results. About one-third of the 490 positive FOBTs examined for this study were not directly reported to PCPs as CPRS alerts.
- Upon correction of the technical problem, lack of timely follow-up of test results decreased from 29.9% to 5.4% -- and was sustained for four months following the intervention.
- The authors recommend that electronic communication of positive FOBT results should be monitored to avoid limiting the benefits of colorectal cancer screening. They are currently investigating whether this problem exists in other VA facilities, or if this was an isolated event.
BACKGROUND:
Early detection of colorectal cancer through timely follow-up of positive fecal occult blood tests (FOBT) remains a challenge, with previous research suggesting that about 40% of Veterans in the VA healthcare system with positive FOBTs do not receive timely diagnostic colonoscopies. An important, largely preventable, yet relatively unexplored reason for lack of follow-up is a problem with communication of the positive test result to the ordering clinician. This study sought to determine if technical and/or workflow-related aspects of automated communication in VA's electronic health record could lead to the lack of response. To achieve this goal, investigators examined 490 positive FOBT alerts at one large, urban VA facility between 5/08 and 3/09. After identifying the source of FOBT alert communication breakdown (i.e. problem with software configuration accompanied by PCP not listed as the ordering provider in the computer), an intervention was developed to correct the problem. Timely follow-up was then measured pre- and post-intervention.
LIMITATIONS:
- There was a lack of comparable data from other VA or non-VA facilities.
- This study did not address other issues that should be considered in addressing follow-up of abnormal test results, including the role of organizations, as well as policies and procedures.
AUTHOR/FUNDING INFORMATION:
This study was partly funded through HSR&D. Drs. Singh, Wilson, and Petersen are part of HSR&D's Houston Center for Quality of Care and Utilization Studies.
Singh H, Wilson L, Petersen L, et al. Improving Follow-Up of Abnormal Cancer Screens Using Electronic Health Records: Trust but Verify Test Result Communication. BMC Medical Informatics and Decision-Making December 9, 2009;9:49.
